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HomeMy WebLinkAbout2537DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -18 BOX 22 02537 Li f I IN 02537 � -- - - - - -- .Try-- -- - - -- -- - - - - - -- - - -- - - - -- -- .- -- - - . PUTNAM COUNTY DEPARTMENTF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 Fermis # CERTIFICATE: OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 11CAA iJVIVI'1 ..TO _ _.. .. ... .. .fin w silage' Located at �,J -• Tax Ma Block Owner �! Formerly, /iii(./ Tax Nap Lot # S . Lot # �' Dn Separate Sewerage System built by '� Adoress 11A Consisting of /10 � Gal. Septic Tank and 1� Other requirements Water Supply: Building Type Public Supply From Private Super Drills Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as own on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordan a ith the filed plan, and the permit issued by the Putnam County Department Of Health." D �J Date f LO 61 Certifi by W P.E. R.A.. Address v &-4 (1 " a ei, . ` License No. Any person occupying premises served by the above systems) shall promptly take such actin as may be neces ry to secu • the correction of any unsanitary conditions resultinil from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become ull and void when a public w ly becomes available. Such approvals are subject to modification or change when, in the Judgment of th Com sioner of Health, such �ocation modification or h- &wrs._ngcn"rv. sw W-1 Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH permit -. - -- �. Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTR CTION . PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam. Valley Town or Village Located at :'Sllleck Boulevard Tax Map 29 Block 2 Lot 7 Subdivision Lakls Oscawana Acres Saba. Lot # 20 Renewal _� _Revision_ Owner /AddressWm• Lubbers, Indian Lk. Rd. east_, Put. Val, NXte Of Previous Approval 9/6/84 . Building Type _Qlle Fajn RPS. Lot Area 1 A,- 000.gy Fill Section Only ❑ Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage :system to consist of 1000 Gal. Septic Tank and 420LF of Leaching Trenches To be constructed by D. Heady Address Canopus Hol . Road, Putnam Val, NY 10579 Water Supply: -- Public Supply From XXX Private Supply to be drilled by Norman Anderson Address Barger St, Putnam Valley, NY 10579 Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will Place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approvals of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be 1 s lied in accordan with the standard rules and regulaa ons of the Putnam County Department of Health. " Date 5/20/85 Signs tl P. E. R.A. $X Address License No. lA5 APPROVED FOR NSTRi`�CTION: This approval expires one yea fro the date issued less construction of the uilding has been undertaken and is revocable for taus or maybe amended or modified when conyiQeretl ice ssary by the ssioner of Health. Any hangs or alteration of construction requires a new rmit. /Approved for disposal of domestl sa ita se ae..and /or water v,nnw .,e1.. ioIr Rfl1L" ALUK... Permit q Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley Town or GTage Located at Sllleck Boulevard Tax Map 29 Block 2 Lot 7 Subdivision Lake Os aw a A' res S . Lot q 20 Renewal Revision [3 __ „ —�. or Owner /Address ee S_ 1 Date Of Previous Approval , y� Building Type One Family Res. Lot Area 189000 SF Fill Section Only E3 Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 420aLF of Leachin Trenches ~! To be constructed by Dori Heady Address a f 10579 Water Supply: Public Supply From ` Private Supply to be drilled by Norman Anderson Address Barger Street, Putnam Val.leV , NY 10579 ..y..i Other Requirements 7 Fto Curtain Drain f 1 represent that i am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons O @ u nem County Department of Health, and that on completion thereof a "Certificate of Construction Compliance” satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the perio, two (2) years Immediately following the date of the ' lssu = ance of the approval of the Certificate of. Construction Compliance of the original system 9T yny repairs thereto; 2) that the drilled well'described above will be located as shown on the approved plan and that said well will be in in actor nce i e standards, r es and regu a� oTi ns of the Putnam County Department of Health. Date June 24, 1983 Signed P.E. R.A. X Address use of No #2 X 488 Maho a 11056 License No. APPROVED FOR CONSTRUCTION: This approval expires one art a date ued unless con tion of the at has been undertaken and is revocable for cause or may be amended or modified when cons' Bred ne ry by t e Commissioner f earth. Any change or alteration of construction requires a n ermit. Approved for, disposal of domestic niter age, r pr' to water pply only. -�j-� Date By Title .,. \ ' Rev. 9 -81 PUT NAM AM 'COUNT'Y DEPARTMENT OF HEALTH Permit q P . V . 3 5.4-. w Division of Envfl'ronmental Health Services, Carmel, N. Y. 10512 " CONSTRU ON PERMIT.FOR SEWAGE DISPOSAL:�SYSTEM Putnam Valley Town or illaT! ge Located at Si 1 1 eek Boulevard Tak Map 29 Block ' 2 Lot ' 'Z Subdivision Lake Ogcawana .A Subd y Lot q 20 Renewal _gj Revision L. D Oa Road 7/12/83 `°. Owner /Address Date Of Previous Approval -':- Building TypeCne Family Res. Lot Area 18,000 SF Fill Section Only ❑ Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank and 420 LF of Leaching Trenches and us ow a T cr o be constructed by D. Heady Address V0 in, Water Supply: Public Supply From j XX Private Supply to be drilled by Norman Anderson a . Address Barger Street, Putnam Valley, NY 10579_;' Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system::. above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations o e- u nam. f' County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will ". place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the hau- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Installed in accordance with the standards, rules and regu a i�f ons of the Putnam .'. County Department of Health. Date 9/4/84 Signed P.E. R.A. X:.:.,.:: Address �ewyor I t RFD #2, Box 488, Mahopac, License No. 11056 APPROVED FOR CONSTRUCTION: This approval expires one ye pr from the date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified wh�1D sidedK - e►ed npeessary by the Commissioner of Health. Any change eration of construction requires a n per it. Approved for disposal of d3'mestic sa sew ge, an or p i water supply only. Date ►l✓ By Title Rev. 9 -81 A -Frame garnished with stone chimney No. 9876 -- Trimmed with balcony and sun deck and garnished with a stone chimney, this A -Frame presents an engaging exterior. Inside, it is evident that the home is intended for all season use. A full bath serves each floor, inc!uding the basement which contains a huge recreation room and boat storage: First floor -1,232 sq. ft., Second floor -717 sq. ft., Basement -1,232 sq. ft. 105 SNOG BEOROOM ' FAMILYOOM 1 }1' K 15-0' :3:: BEDROOM II:B' % IB : o 12 =0' K ITte. BOAT GARAGE C " 18-0' K 21:1' STOR. W. O. T. (` BATH " B. B. () + OECN " C ��11 K(TCNEN 'p IIQ'K9&O' .0 RECREATION ROOM .� .,I 26 =8' S 17'8' BEDROOM LIVING ROOM 2S.4' K 12 -0' .12' -O'K 17 =9' BPSEMENT DECK _ BALCONY SECOND ,- F FIRST FLOOR 28 =0' FLOOR N0. 9074 A -Frame garnished with stone chimney No. 9876 -- Trimmed with balcony and sun deck and garnished with a stone chimney, this A -Frame presents an engaging exterior. Inside, it is evident that the home is intended for all season use. A full bath serves each floor, inc!uding the basement which contains a huge recreation room and boat storage: First floor -1,232 sq. ft., Second floor -717 sq. ft., Basement -1,232 sq. ft. 105 [: I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY:- OFFICE- BUILDING;-: CARMEL, N. Y: 10512 DESIGN DATA SBEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner L. Yanni Address 14 Oakwood Road, Peekskill, NY TM Located at (Street WSdicate illeck Blvd RXX 9 Block 2 Lot 7 nearest cross* ross s ree MunicipsLlity. Town of Putnam Valley Watershed Hudson River SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e- Number CLOCK TIME PERCOLATION PERCOLATION uF apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches #1 1 8:00 -8:33 33 16 19 3 33/3 =11 2 8:34-9:07 33 16 19 3 33/3 =11 3 9:08 -9:41 33 16 19 3 33/3 -11 4 9:42 -10:15 33 16 19 3 33/3 =11 #2 1 8:05 -8:38 33 16 19 3 33/3 =11 ._.:.3.3 _. ...__ .: .,... 1.6., ...__.w_ :.:::__19 : :.: 3 `_ :..'.: 33/.3=11 ...__ :_ ... 3 9 :13 -9:46 33 16 19 3 33/3 =11 4 9; :47 -10:20 33 16 19 3 33/3 -11 5 1 2 3 _ 5 T Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. d� s s TEST PIT DATA REQUIRED TO.BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. DTH HOLE NO. HOLE NO. G.L. Top Soil 6" Sand, Small Stones '& Some -Clay 1211 1811 ' 2411 " 3011 36" " 42 ►' 4811 11 5411 60" „ 66" 7211 7811 8411 " INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 4H INDICATE LEVEL T.O .-WFIICH. WATER. LEVEL RISES AFTER 'BEING: ENCOUNTERED. 4 Ft TESTS­ MADE'BY^ - -Joel Greenberg Dat6 May Il_, ..1.983_ - DESIGN Soil Rate Used 11- 15Min/1 "Drop: S.D. Usable Area.Provided .5,000 SF No. of Bedrooms 3 Septic Tank Capacity 1 000 Gals Ts Pre -cast Conc® Absorption Area Pr— o By 400 L.F.x24" w Eo trench. / �C R�tSCE R' % CV o--TA/m iJ LA /N Name Joel Greenberg Signature Address RFD #2, Box 488, Muscoot Nrth,,' Mahopac. NY 10541 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by ]ate h,- Yorktown Medical Laboratory, Inc. LOCATIONS: ,321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203. 321 Kear Street ❑ 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737 -8777 ` York town tHeights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 (914) 245 -3203 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL. N. Y. 10512 278.9330 Director: M.- T..- (ASCP) - PATE 1112/85: (.2' :20. P.M�) ` (- TAKEN: DATE RECEIVED- 11/4/85 (12 :50 P.M.) DATE REPORTED: 11/6 85 WILLIAM LUBBERS KITCHEN TAP: SAMPLE SOURCE. Lab N SELT.ICK ROAD PUTrTAM VALLEY, NY 10579 , CROSSROADS PHARMACY REFERRED BY: MRS. LUBBERSr2Q22U', L_ J Collector• 528 -4688 LABORATORY REPORT. mg /L ❑ ACIDITY ............................ ............:.................. ❑ ALUMINUM . ..... ..... ❑ ALKALINITY i P ° ..... A= ............. ❑ ANTIMONY ............................................ ................... BACTERIA, TOTAL /mL ....... .. ... r ........................ O ARSENIC ..................................... ............................... OBOD, 5 DAY ............................................................ ❑ BARIUM ...... .. ....................... ............................... OBROMIDE ............................ ............................... ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE ....................................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ............................ ........:...................... ❑ BORON ........................................ ............................... ❑ CHLORINE ..............:............. ..:.....:...................... ❑CADMIUM .................................... ............................... OC00 .................................... ............................... ❑ CALCIUM .................................... ............................... OCOLOR (units) ................. ............................... ❑ CHROMIUM (tot.) ........................................................... O CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalentl ❑ DETERG ENT, ANIONIC .....................: ❑ COBALT OFLUORIOE ............................ ............................... • ❑ COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD .... ............................... . ............................... O MPN COLIFORM COUNT/ 100 ml ....... .... .... ................ ............... ❑ IRON ......................... ............................... '�NI TCOLIFORM COUNT/ 100 ml .. ..................... ❑ LEAD ........................................ ............................... OCONFIRMATORY TEST ............ ..............................: ❑ LITHIUM .................................... ............................... ........ .............................. ❑ NITROGEN, AMMONIA ............................................ ❑ MAGNESIUM .............................. ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ............................... ONITROGEN, NITRATE ............ ............................... ❑ MERCURY .................................... ............................... _..... _._...__. -. .... _ ... _.._. ... ... ......... e...................... ... ❑ NC ...::....... ........r........::.........O _ IKEL.................:: 4 ........: - OODOR (units) ................ ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM, ... ................................................ :........... ❑ PH (Utl i t S ) ...................... ............................... ❑ RHODIUM .................................... ............................... OPHENOL ................................ ............................... ❑ SELENIUM ..................................... ............................... . ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SODIUM ........................................ ............................... GSOLIDS, SETTLEABLE, mill. ................................... ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ............: ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED ............. ............................... ❑ ..............................................:..... ............................... ❑ SOLIDS. TOTAL ...................................................... ❑ .................................................... ............................... ❑ SOLIDS, VOLATILE ................. ............................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE (uhmo S / cm) ............... • ❑ .................................................... ............................... ❑ SULFATE ............................. ............................... ❑ .................................................... ............................... ❑ SULFIDE ........................... ............................... .. .... .. ............................................. ............................... ❑ ........................................ ❑ SULFITE ...... ............................... ❑ ......:..................... ...... 11-SURFACTANTS; ... .............. ............................... ❑ ............................... ......:........................ . . ❑ TURBIDITY ( NTU). .... ............................... ....... ❑ .. ..................................:.......... ............................... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY . QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT'THE WATER DI MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW'YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED WHEN THE SAMPLE, WAS CO CTED. N/A = not applicable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES 31k- 3 Date Re: Property of MR, Located at 1 LLEC*l 13L\./P, Section � Block Lot ,Gentlemen: This letter is to authorize 11305L, Br -a -duly licensed professional engineer. or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner.of the Putnam County Department of Health, and to sign all necessary papers on my behalf in vvAij1Cv 11.u11 w 1 Ln Lttib Ilia L Lev and . to. supervise the construe ciun of said system or systems in conformity with the provisions of Article 145 or 147, Eduoation Law, the Public Health Law, and the Putnam County Sani- tary Code. ti Very truly purs, Sig— Owner of 1' 6perty Countersigned: P.E., R.A., Address - ioaicree� rg= Architect Mu oot North RFD�2 Box 488 I . Mchopoc, NY 10541 Telephone 1� 0'qk' t) i)0 [) P-D. Address, Sh: i,i � , NY, gos�,� q/ 4.- % -3 -2 - ol*a1 Telephone WELLAOMPLETION REPORT PVTNAM COUNTY DEPARTMENT..OF. HEALTH 3171 ' Division. of £nvlror►lnantal Health Savior COUNTY, OFFICE.. BUILDING - CARMEL, NEW YORK This report is to be completed by well-filler and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER . NAME ADDRESS LOCATION OF WELL (NO. a su (Toisn) . j (Lot Numooi) PROPOSED USE OF WEII D DOMESTIC El SUPPLY BUSINESS TABL ❑ ESTABLISHMENT 1:1 INDUSTRIAL ❑ FARM ❑ CONDITIONING TEST WELL. ❑ (SpeHEy) EQU:I ►MENT © ROTARY COMPRESSED ❑ AIR PERCUSSION CABLE ❑ PERCUSSION ❑ 0" City) CASINO DETAILS LENGTH (loot) l DIAMETER (inches) � WEIGHT PER FOOT 17. THREADED ❑ WELDED V1 $NO nyrs NC) CASINO ultur YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED CJ COMPRESSED AIR G.I.M. YIELD (a.P.Sf.) WATER LEVEL MEASURE FROM LAND SURFACE— StATIC(SPocity lee►) DURING YIELD TEST (lost) Depth of Completed Well in feet below land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (teen DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of wall including. gravel pack pnthes): RAVEL SIZE (l s) Irad) TO (feel) DI►Th F10M LAND SURFACE FORMATION DESCRIPTION Sketch oxacl location of well with diatsaCas, to at ks"t two Permanent Nndeterke. _ — ►EE1 se .FEET If Yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE E l C I:iED i ` f7 � t,1� DATE OF REPORT J�VEL DRILL ( iyn re) f I o� �014t4 ---- 71- 77-11 i6-$ : a62" "Ji I L L E GK B